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Cluster B
Antisocial Personality Disorder
Antisocial personality disorder (ASPD) is characterized by a persistent
disregard for, and frequent violation of, other people's rights. The
prevalence rate is 3 percent in males and only 1 percent in females. The
disorder does seem to dissipate or burnout after the age of forty, which could
be associated with hormonal changes at that age. ASPD is mostly comorbid with
narcissistic personality disorder. Most
etiology paradigms seem to imply a high
interaction between the environment and genes for this disorder. Empirical
evidence using adoption studies has found that
regardless of genes, if an individual is raised in a highly stressful
environment, he or she is still at great risk of developing ASPD.
Neurobiological factors that may contribute to the onset and maintenance of this
disorder are a weak behavioral inhibition system and an overactive reward
system. The behavioral inhibition system is responsible for stopping behavior
that may incur punishment. Psychopaths (people diagnosed with ASPD) tend to
exhibit a type of habituation to punishment, wherein their physiological
reaction to punishment is very weak. Psychopaths may also possess an overactive
reward system wherein once there has been some reward in sight; even if the
situation changes, they are unable to move away from the established goal.
Individuals with antisocial personality rarely seek professional help, and
unfortunately, no form of treatment has been effective in treating this
disorder.
Borderline Personality Disorder
Borderline personality disorder is characterized by marked impulsiveness and
instability in mood, self-image, and
interpersonal relationships. Manifestations of this disorder include frantic
efforts to avoid real or imagined threats of abandonment, with opinions of
significant others fluctuating between unrealistic positive and negative
extremes. Individuals in this category tend to engage in para-suicidal
behaviors such as cutting themselves. The hypothesis to explain these behaviors
is that these types of acts help to break feelings of
dissociation that these
individuals usually experience. There are also high rates of suicide attempts
in this category. The prevalence rate of borderline personality disorder is
about 2 percent and 75 percent of the cases involve women. If the individual
lines into his or her thirties, the symptoms tend to diminish, but about 60
percent of these individuals end their life in
suicide. Borderline personality disorder is
highly comorbid with histrionic and avoidant personality disorders. The
disorder is called "borderline" because individuals in this category tend to be
on the borderline between psychotic and
neurotic disorders.
Family studies indicate that there may be a possible link between borderline
personality disorder and mood disorders. There are also very high report rates
of incidence of childhood physical and sexual abuse among people with this
disorder, suggesting a possible specific link between these two factors.
Although no disorder-specific drug has yet been found, a broad range of
psychoactive drugs, ranging from
antipsychotics and antidepressants to lithium and
anticonvulsants, have been proven effective
forms of treatment. Dialectical behavior therapy (DBT) has also
been shown to be a promising treatment of borderline individuals. In this form
of therapy, traditional behavioral and cognitive techniques such as problem-
solving and skills training are used to maintain working interpersonal
relationships and cope with stress, while the therapist concentrates on
accepting the contradictory, demanding, and manipulative behaviors of the
patient.
Histrionic Personality Disorder
Histrionic personality disorder is characterized by excessive emotionality,
overreaction to everything, and attention-seeking behavior. Individuals with
this disorder are self-centered, vain, and demanding, and possess shallow
emotions that fluctuate rapidly. The prevalence rate ranges from 2 to 3 percent
and is higher in divorced or separated individuals. The disorder, which follows
a chronic course, is highly comorbid with borderline and narcissistic
personality disorders. One etiological explanation for this disorder comes from
the psychoanalytic theory of parental
seductiveness. Basically, this theory states that individuals who exhibit
histrionic personality disorder had parents who chastised them for sexual
behavior, while actually encouraging it at the same time. This led to
conflicting signs concerning sexual indulgence, and subsequently to over-
theatrical performances. Proof for this theory comes from the fact that the
characteristic of emotional overreaction usually tends to have a sexual element
or suggestion.
Narcissistic Personality Disorder
Narcissistic personality disorder is characterized by a grandiose view of
self and an inability to empathize with others, for these individuals are
preoccupied with their own achievements and abilities. This disorder is not
chronic, and usually remits with time. Narcissistic personality disorder has a
prevalence rate of about 1 percent. It is highly comorbid with histrionic
and borderline personality disorders. One etiological explanation of this
disorder can be found in the psychoanalytical area, which says that individuals
suffering from narcissistic personality disorder tend to have a bi-polarity in
their view of self, existing between two extremes: there is an idealized or
over-idealized view of self, but this is combined with deep feelings of
inferiority and low self-esteem. The grandiose image, then, is an attempt to
cover feelings of inferiority. According to the proponents of this theory,
since these individuals did not receive much encouragement and support from
their parents during childhood, they tend to internalize the process by looking
for these feelings within themselves.
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